Should pulmonary computed tomography be performed in children with tuberculosis infection without apparent disease?

Abstract

Background During early childhood, in particular, there is a continuum between tuberculosis infection and disease. When establishing the diagnosis in a child with suspected tuberculosis, the distinction between infection and disease frequently depends on the interpretation of the chest X-ray. Some studies have shown hilar and mediastinal lymphadenopathies on computed tomography (CT) in children with tuberculosis infection without apparent disease, i.e., asymptomatic children with a positive tuberculin skin test and normal chest X-ray. These observations raise the issue of whether pulmonary CT should be performed in children with tuberculosis infection without apparent disease and whether different types of therapy should be administered depending on the results. Methods We reviewed the physiopathology of tuberculosis infection and disease, diagnostic methods and treatment, and the literature on the use of pulmonary CT scan in pediatric tuberculosis. Results Modern CT scanners indicate hilar and mediastinal lymphadenopathies in many of the children with tuberculosis infection with no apparent disease on chest X-rays. However, neither the size nor the morphology of these adenopathies allows active tuberculosis to be diagnosed. The natural history of childhood tuberculosis indicates that most children show hilar lymphadenopathies after the primary infection, although progression to disease is rare and is characterized by the presence of clinical symptoms. The exceptions are children younger than 4 years old and those with immune alterations who more frequently show progression of infection to disease and who require close follow-up. In addition, the experience accumulated over many years in the treatment of tuberculosis infection with isoniazid has shown this drug to be effective in both short-and long-term prevention of active disease. Official guidelines and expert opinion do not recommend systematic pulmonary CT scan in these children or modification of treatment according to the results. Conclusions Hilar and mediastinal lymph nodes are frequently found in the CT scans of children with tuberculosis infection without apparent disease but there is no evidence that these adenopathies indicate active disease or that these children require different treatment. Consequently, until demonstrated otherwise, pulmonary CT scanning and changes in chemoprophylaxis are not justified in children with tuberculosis infection.

Diagnosis of Pulmonary Tuberculosis in Children

“…However, there is no evidence that correspond with the active disease, and the natural history of the disease suggests that they may be a part of the primary tuberculosis infection. The official national and international recommendations and opinions of prestigious authors do not recommend performing CT on the asymptomatic child, with a positive tuberculin test and with a normal chest X-ray, or to take a particular therapeutic path depending on their results [60].…”

Çocukluk Çağı Akciğer Tüberkülozu Tanısında Bilgisayarlı Tomografinin Yeri

“…Gomez ve arkadaşları kültür negatifliği ve normal GR bulguları olan TDT pozitif asemptomatik hastaların %63'ünde tBT ile çoğunlukla paratrakeal bölge yerleşimli patolojik lenf nodları bulmuştur (32). Peng ve arkadaşları kalsifiye ve kazeik nekrotik lenf nodlarının TB için karakteristik olduğunu öne sürmüşlerdir (26).…”

Computed Tomography Findings of Pulmonary Tuberculosis in Childhood

“…Dört-6 hafta içinde bölgesel lenf nodlarına yayılır. Ghon foküsü, lokal lenfanjitik yayılım ve bölgesel lenf nodu tutulumu ile Ghon kompleksini oluşturur (5) . Akciğer tüberkülozunun çok çeşitli BT bulguları izlenmektedir.…”

“…Hem erişkinlerde hem de pediatrik yaş grubunda ilk parankimal lezyon genellikle pnömonik konsolidasyondur (5) . Konsolidasyon segmental, lobar veya multifokal olabilir.…”